1
|
Vaher U, Ilves N, Ilves N, Laugesaar R, Männamaa M, Loorits D, Kool P, Ilves P. Vascular syndrome predicts the development and course of epilepsy after perinatal stroke. Epileptic Disord 2024; 26:471-483. [PMID: 38727601 DOI: 10.1002/epd2.20239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Epilepsy develops in one third of the patients after perinatal stroke. It is still unclear which vascular syndrome of ischemic stroke carries higher risk of epilepsy. The aim of the current study was to evaluate the risk of epilepsy according to the vascular syndrome of perinatal stroke. METHODS The study included 39 children with perinatal arterial ischemic stroke (13 with anterior or posterior trunk of the distal middle cerebral artery occlusion, 23 with proximal or distal M1 middle cerebral artery occlusion and three with lenticulostriate arteria infarction), and 44 children with presumed perinatal venous infarction. Magnetic resonance imaging obtained at the chronic stage was used to evaluate the vascular syndrome of stroke. RESULTS The median follow-up time was 15.1 years (95% CI: 12.4-16.5 years), epilepsy developed in 19/83 (22.9%) patients. The cumulative probability to be without epilepsy at 15 years was 75.4% (95% CI: 65.8-86.4). The probability of having epilepsy was higher in the group of proximal or distal M1 artery occlusion compared to patients with periventricular venous infarction (HR 7.2, 95% CI: 2.5-26, p = .0007). Patients with periventricular venous infarction had significantly more often status epilepticus or spike-wave activation in sleep ≥85% of it compared to patients with anterior or posterior trunk of the distal middle cerebral artery occlusion (OR = 81; 95% CI: 1.3-5046, p = .029). SIGNIFICANCE The emphasis of this study is placed on classifying the vascular syndrome of perinatal stroke and on the targeted follow-up of patients for epilepsy until young adulthood. The risk for having epilepsy after perinatal stroke is the highest in children with proximal or distal M1 middle cerebral artery occlusion. Patients with periventricular venous infarction have a more severe course of epilepsy.
Collapse
Affiliation(s)
- Ulvi Vaher
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Norman Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Nigul Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Pediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mairi Männamaa
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Pilvi Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| |
Collapse
|
2
|
Pabst L, Hoyt CR, Felling RJ, Smith AE, Harpster K, Pardo AC, Bridge JA, Jiang B, Gehred A, Lo W. Neuroimaging and Neurological Outcomes in Perinatal Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. Pediatr Neurol 2024; 157:19-28. [PMID: 38848613 DOI: 10.1016/j.pediatrneurol.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Prediction of outcomes in perinatal arterial ischemic stroke (PAIS) is challenging. We performed a systematic review and meta-analysis to determine whether infarct characteristics can predict outcomes in PAIS. METHODS A systematic search was conducted using five databases in January 2023. Studies were included if the sample included children with neonatal or presumed PAIS; if infarct size, location, or laterality was indicated; and if at least one motor, cognitive, or language outcome was reported. The level of evidence and risk of bias were evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analyses were conducted comparing infarct size or location with neurological outcomes when at least three studies could be analyzed. RESULTS Eighteen full-text articles were included in a systematic review with nine included in meta-analysis. Meta-analyses revealed that small strokes were associated with a lower risk of cerebral palsy/hemiplegia compared with large strokes (risk ratio [RR] = 0.263, P = 0.001) and a lower risk of epilepsy (RR = 0.182, P < 0.001). Middle cerebral artery (MCA) infarcts were not associated with a significantly different risk of cerebral palsy/hemiplegia compared with non-MCA strokes (RR = 1.220, P = 0.337). Bilateral infarcts were associated with a 48% risk of cerebral palsy/hemiplegia, a 26% risk of epilepsy, and a 58% risk of cognitive impairment. CONCLUSIONS Larger stroke size was associated with worse outcomes across multiple domains. Widely heterogeneous reporting of infarct characteristics and outcomes limits the comparison of studies and the analysis of outcomes. More consistent reporting of infarct characteristics and outcomes will be important to advance research in this field.
Collapse
Affiliation(s)
- Lisa Pabst
- Division of Neurology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
| | - Catherine R Hoyt
- Program in Occupational Therapy, Department of Neurology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan J Felling
- Department of Neurology & Kennedy Krieger Institute, Johns Hopkins Medicine, Baltimore, Maryland
| | - Alyssa E Smith
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Andrea C Pardo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry & Behavioral Health, Nationwide Children's Hospital and The Ohio State University College of Medicine, Center for Suicide Prevention and Research, Columbus, Ohio
| | - Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Stanford, California
| | - Alison Gehred
- Nationwide Children's Hospital Library, Columbus, Ohio
| | - Warren Lo
- Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
3
|
Vaher U, Ilves N, Ilves N, Laugesaar R, Männamaa M, Loorits D, Kool P, Ilves P. The thalamus and basal ganglia are smaller in children with epilepsy after perinatal stroke. Front Neurol 2023; 14:1252472. [PMID: 37840930 PMCID: PMC10568465 DOI: 10.3389/fneur.2023.1252472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Background Epilepsy is one of the most serious consequences of perinatal stroke. Epilepsy itself has been proposed as a risk factor for impaired cognitive, language, and behavioral functioning. It is still unclear which children develop epilepsy after perinatal stroke. The current study aimed to evaluate the volume of the thalamus and the basal ganglia in children after perinatal stroke in relation to poststroke epilepsy. Methods The follow-up study included 29 children with perinatal arterial ischemic stroke (AIS), 33 children with presumed periventricular venous infarction (PVI), and 46 age- and sex-matched healthy controls. Magnetic resonance imaging was performed in children between the ages of 4 and 18 years, and volumetric analysis by segmentation was used to evaluate the size of the thalamus, caudate nucleus, putamen, globus pallidus, hippocampus, amygdala, and nucleus accumbens. Results During a median follow-up time of 12.8 years [interquartile range (IQR): 10.8-17.3] in the AIS group and 12.5 years (IQR: 9.3-14.8) in the PVI group (p = 0.32), epilepsy developed in 10 children (34.5%) with AIS and in 4 (12.1%) children with PVI, p = 0.036 [odds ratio (OR) = 3.8, 95%, confidence interval (CI): 1.04-14]. Epilepsy and interictal epileptiform discharges (IEDs) without clinical seizures were more often expressed in children with AIS (n = 16, 55%) than in children with PVI (n = 7, 21.2%), p = 0.0057 (OR = 3.8 95% CI: 1.04-14). In the AIS group, the ipsilesional and contralesional thalamus, ipsilesional caudate nucleus, and nucleus accumbens were significantly smaller in children with epilepsy compared to children without epilepsy. In the PVI group, the ipsilesional thalamus, caudate nucleus, and nucleus accumbens were smaller in the pooled group of epilepsy plus IED alone compared to children without epilepsy. Conclusion In children with AIS, epilepsy or IED occurred more often compared to children with PVI. Both patients with AIS and PVI with severe damage to the basal ganglia and the thalamus have a higher risk of developing poststroke epilepsy and should be monitored more closely throughout childhood to initiate timely antiseizure medication and rehabilitation.
Collapse
Affiliation(s)
- Ulvi Vaher
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Norman Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Nigul Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Pediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mairi Männamaa
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Pilvi Ilves
- Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| |
Collapse
|
4
|
Giraud A, Dinomais M, Garel P, Chevin M, Thébault G, Renaud C, Presles É, Raia-Barjat T, Sébire G, Chabrier S. Perinatal inflammation exposure and developmental outcomes 7 years after neonatal arterial ischaemic stroke. Dev Med Child Neurol 2023; 65:1073-1080. [PMID: 36700522 DOI: 10.1111/dmcn.15522] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Abstract
AIM To test the association between perinatal inflammation exposure and Full-Scale IQ (FSIQ) score 7 years after neonatal arterial ischaemic stroke (NAIS). METHOD We conducted a cross-sectional ancillary study nested in a multicentric longitudinal French cohort of infants born at term with NAIS between November 2003 and October 2006. Seventy-three children were included (45 males, 28 females). The a priori defined primary outcome measure was the FSIQ score assessed with the Wechsler Intelligence Scale for Children, Fourth Edition at 7 years of age. RESULTS Seventeen (23%) of the included children were exposed to perinatal inflammation. Exposure to perinatal inflammation was independently associated with an increase of FSIQ score (coefficient 13.4, 95% confidence interval 1.3-25.4; p = 0.03). Children exposed to perinatal inflammation had a higher median cerebral volume, a lower median lesion volume, and less extensive lesion distributions compared to non-exposed children. INTERPRETATION We propose the existence of two NAIS categories: arteritis-associated NAIS in children exposed to perinatal inflammation and embolism-associated NAIS in children non-exposed to perinatal inflammation. Identifying these two NAIS categories would open the possibility for specific curative strategies: anti-inflammatory strategy in arteritis-associated NAIS and recanalization strategy in embolism-associated NAIS.
Collapse
Affiliation(s)
- Antoine Giraud
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Mickaël Dinomais
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Pauline Garel
- Centre National de Référence de l'AVC de l'Enfant, Médecine Physique et Réadaptation Pédiatrique, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Mathilde Chevin
- Child Neurology Division, Department of Paediatrics, McGill University, QC, Canada
| | - Guillaume Thébault
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Paul Coste Floret, France
| | - Cyrille Renaud
- Centre National de Référence de l'AVC de l'Enfant, Médecine Physique et Réadaptation Pédiatrique, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Émilie Presles
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | | | - Guillaume Sébire
- Child Neurology Division, Department of Paediatrics, McGill University, QC, Canada
| | - Stéphane Chabrier
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- Centre National de Référence de l'AVC de l'Enfant, Médecine Physique et Réadaptation Pédiatrique, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| |
Collapse
|
5
|
Vojcek E, Gráf R, László AM, Gyebnar G, Seri I. Long-term neurodevelopmental outcome of neonates born at term with perinatal haemorrhagic stroke: A population-based study. Dev Med Child Neurol 2022; 64:971-978. [PMID: 35137402 PMCID: PMC9305871 DOI: 10.1111/dmcn.15149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
AIM To assess the long-term neurodevelopmental outcome of neonates born at term diagnosed with perinatal haemorrhagic stroke (PHS) and investigate the associations among brain territorial involvement, clinical risk factors, and neurodevelopmental outcomes. METHOD We conducted a population-based study enrolling 55 neonates born at term with PHS confirmed by magnetic resonance imaging born between 2007 and 2017. Long-term neurodevelopmental outcome was assessed using the Bayley Scales of Infant Development, Second Edition, the Brunet-Lézine test, and the Stanford-Binet Intelligence Scales, Fifth Edition. RESULTS Follow-up was available in 50 (91%) of the infants, at a median age of 60 months (interquartile range 35-88). Forty per cent of the infants developed according to population norms, and developmental disabilities were diagnosed less frequently among neonates with frontal lobe PHS. In a multivariable model, parietal lobe PHS increased the risk for cerebral palsy (odds ratio [OR] 6.7; 95% confidence interval [CI] 1.1-41.4) and cognitive impairment (OR: 23.6; 95% CI: 2.9-194.9), while the involvement of the thalamus and/or basal ganglia was associated with epilepsy (OR: 7.0; 95% CI: 1.3-37.7). Seizures on admission were associated with epilepsy (OR: 10.8; 95% CI: 1.8-64.3). Patients with PHS affecting multiple lobes had poor prognosis. INTERPRETATION Parietal lobe haemorrhage, the involvement of the thalamus/basal ganglia, PHS affecting multiple lobes, and seizures were independent predictors of chronic neurodevelopmental sequelae, suggesting that the stroke territorial involvement and clinical risk factors influence the outcome of PHS.
Collapse
Affiliation(s)
- Eszter Vojcek
- First Department of PediatricsSemmelweis UniversityBudapestHungary,Department of PediatricsSzent János Hospital and North Buda United HospitalsBudapestHungary
| | - Rózsa Gráf
- Department of RehabilitationSzent János Hospital and North Buda United HospitalsBudapestHungary
| | - Anna M. László
- Department of Applied StatisticsInstitute of Mathematics and Basic SciencesHungarian University of Agriculture and Life SciencesBudapestHungary
| | - Gyula Gyebnar
- Department of NeuroradiologyMedical Imaging CenterSemmelweis UniversityBudapestHungary
| | - Istvan Seri
- First Department of PediatricsSemmelweis UniversityBudapestHungary,Department of PediatricsChildren’s Hospital Los AngelesUniversity of Southern CaliforniaLos AngelesCAUSA
| |
Collapse
|